Gastrointestinal and Anal Hospital, Sun Yat-Sen University, Guangdong, China.
Am J Clin Oncol. 2011 Jun;34(3):314-6. doi: 10.1097/COC.0b013e3181dea970.
To explore the role of neoadjuvant imatinib mesylate (IM) therapy in sphincter-preserving procedures for anorectal gastrointestinal stromal tumor (GIST).
Between January and December of 2007, 3 patients with primary anorectal GIST who declined recommendations to receive abdominoperineal resection of the rectum, were treated with IM at a single institution. Tumor size, distance to anal edge, and the number of mitoses were compared before and after the treatment. After 12 weeks of IM therapy, conservative surgical procedures were performed.
After IM therapy for the 3 patients, computed tomography scan, colonoscopy, and biopsy showed a decrease in size of the rectal mass, an extension in the distance to anal edge, and a reduction in mitotic count. During this treatment regimen, the patients did not experience any side effects. A sphincter-preserving transsacral excision with direct coloanal anastomosis was performed and the resection margins were uninvolved on all sides. During 22 to 28 months postoperatively, the function of anal sphincter was satisfactory and no recurrence occurred among all 3 patients.
Neoadjuvant IM therapy for anorectal GIST is safe and effective. Tumor shrinkage and an extension of the distance to anal edge have a clear benefit for the local excision, in terms of feasibility, function preservation, and safety.
探讨新辅助甲磺酸伊马替尼（IM）治疗在保留肛门直肠胃肠道间质瘤（GIST）手术中的作用。
2007 年 1 月至 12 月，3 例拒绝接受腹会阴直肠切除术的原发性肛门直肠 GIST 患者在单机构接受 IM 治疗。比较治疗前后肿瘤大小、距肛缘距离和有丝分裂数。IM 治疗 12 周后，行保守手术。
3 例患者 IM 治疗后，CT 扫描、结肠镜和活检显示直肠肿块缩小，距肛缘距离延长，有丝分裂计数减少。在此治疗方案中，患者未出现任何副作用。行经骶尾切除直肠伴直接结肠肛管吻合术，所有部位的切缘均无肿瘤累及。术后 22 至 28 个月，肛门括约肌功能满意，3 例患者均无复发。
新辅助 IM 治疗肛门直肠 GIST 安全有效。肿瘤缩小和距肛缘距离延长对局部切除的可行性、功能保留和安全性有明显益处。
